1
|
Apfelbach CS, Sandage M, Abbott KV. Vocal Fold Vibratory Dose and Perceived Exertion Responses to the Fluid Interval Test for Voice (FIT-V): A Novel Vocal Loading Task Platform. J Voice 2024:S0892-1997(24)00263-7. [PMID: 39244385 DOI: 10.1016/j.jvoice.2024.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 09/09/2024]
Abstract
INTRODUCTION Vocal loading tasks are often used to study how specific variables influence downstream vocal effort or fatigue. The current study introduces a novel vocal loading task, the Fluid Interval Test for Voice (FIT-V) that combines laryngeal diadochokinesis, intervallic rest and exercise, and fluid back pressure. To assess the differences between this novel task and existing vocal loading tasks, we measured vocal fold vibratory dose and perceived phonatory exertion across three 30-minute task conditions: a control loud oral reading task (LOR), a back pressure-resisted Fluid Interval Test for Voice (FIT-V5), and an unresisted Fluid Interval Test for Voice (FIT-V0). METHODS Following a training session, 30 participants completed the three tasks (LOR, FIT-V0, and FIT-V5) in counterbalanced order on different days. Vocal fold cycle (Aim 1A) and distance doses (Aim 1B) were collected continuously using a dosimeter. The overall perceived phonatory exertion (Aim 2A) was rated once per minute, while anatomically localized cognitive, laryngeal, thoracic, abdominal, and articulatory exertion (Aim 2B) were rated once at the end of each task. Statistical analyses examined the effects of task and task× time interactions on the dependent variables. RESULTS The FIT-V0 and FIT-V5 tasks imposed smaller vocal fold cycle doses (P < 0.001; Aim 1A) and distance doses (P < 0.001; Aim 1B) than the LOR task while eliciting comparable or greater magnitudes of overall perceived phonatory exertion (P = 0.003; Aim 2A). However, anatomically localized perceived exertion was greater in the abdomen and thorax (P < 0.05) and lesser in the anterior neck (P < 0.05) in the two FIT-V tasks relative to the LOR task (Aim 2B). Absolute forced vital capacity was a significant predictor of most forms of anatomically localized perceived exertion. DISCUSSION The unresisted FIT-V0 and the back pressure-resisted FIT-V5 tasks yielded similar profiles of overall perceived phonatory exertion, despite vocal fold vibratory doses roughly half that of the LOR task. However, the anatomically localized perceived exertion data underscored subtle across-task differences not apparent in the overall ratings, suggesting potentially distinct physiological and perceptual niches for the three task protocols.
Collapse
Affiliation(s)
- Christopher S Apfelbach
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis, Minnesota.
| | - Mary Sandage
- Department of Speech, Language & Hearing Sciences, Auburn University, Auburn, Alabama
| | | |
Collapse
|
2
|
Oliveira P, Ribeiro VV, Florêncio DSF, Palhano M, Gonçalves RR, Alves do Nascimento M. Vocal Training in Healthy Individuals: A Scoping Review. J Voice 2024; 38:1250.e11-1250.e23. [PMID: 35400555 DOI: 10.1016/j.jvoice.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aimed to map the characteristics and effects of vocal training approaches in individuals with healthy voice. METHODS This is a scoping review based on three research questions: What are the interventions used for vocal training of individuals with healthy voice? What are their prescription parameters? What are their effects? The search was conducted electronically in the databases of Embase, Lilacs, Medline, Scopus, and Web of Science. The study selection was based on the reading of titles, abstracts, and full text, applying the eligibility criteria. Data related to the characteristics of the publication, sample, and intervention were extracted. Measures/outcomes and results were also extracted. Quantitative synthesis was performed, and the results were presented in descriptive format. RESULTS In total, 221 studies were identified during the search, of which 23 were selected. The most frequently used approach in the vocal training of individuals with healthy voice was the Semi-Occluded Vocal Tract Exercise (SOVTE), mainly with tube and straw phonation. Many studies have focused on the immediate effect, with varying dosages. The main outcome measures were acoustic analysis, aerodynamic evaluation, electroglotography, and vocal self-assessment. Positive effects were mainly observed on aerodynamic and acoustic parameters. Only one study reported negative results in the self-assessment. CONCLUSION The SOVTE is most frequently performed to provide an immediate effect in the acoustic analysis and has also demonstrated positive effects on vocal self-assessment. Medium and long-term effects and dosages are rarely reported and should be also investigated.
Collapse
Affiliation(s)
- Priscila Oliveira
- Department of Speech Therapy, Universidade Federal da Paraíba - UFPB, João Pessoa (PB), Brazil.
| | - Vanessa Veis Ribeiro
- Department of Speech Therapy, Universidade Federal da Paraíba - UFPB, João Pessoa (PB), Brazil
| | | | - Manoel Palhano
- Department of Speech Therapy, Universidade Federal da Paraíba - UFPB, João Pessoa (PB), Brazil
| | | | - Maiara Alves do Nascimento
- Universidade de Brasília, Campus Ceilândia, Brasília (DF), Brazil; Department of Health School, Escola de Ensino Superior do Agreste Paraibano - EESAP, Guarabira (PB), Brazil
| |
Collapse
|
3
|
Apfelbach CS, Sandage M, Abbott KV. Effects of Back Pressure on the Feasibility and Tolerability of Laryngeal Diadochokinetic Exercise: A Pilot Study. J Voice 2024:S0892-1997(24)00158-9. [PMID: 38969542 DOI: 10.1016/j.jvoice.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND The term vocal demand response refers to how speakers meet vocal demands. Vocal loading tasks with predetermined demand parameters (duration, pitch, loudness, etc) have been used in research to study the vocal demand response; these have historically consisted of loud sustained vowel and loud speech tasks. Tasks founded on laryngeal diadochokinesis (LDDK) may be viable alternatives, especially if demand parameters such as exercise-rest ratio and fluid back pressure are concurrently modulated. OBJECTIVES To explore the effects of four fluid back pressure conditions (0, 5, 10, and 15 cm H2O) on several measures of subjective participant experience, feasibility, and tolerability during intervallic laryngeal diadochokinetic exercise. METHODS Participants (n = 12) completed 15-minute trials of LDDK in 30-second rest and exercise intervals against four counterbalanced back pressure conditions: 0, 5, 10, and 15 cm H2O. The effects of back pressure on (1) ratings of perceived vocal exertion, (2) prevalence of adverse effects such as shortness of breath or lightheadedness, (3) subjective difficulty of sustaining LDDK, (4) number of exercise intervals completed, (5) rankings of participant-preferred back pressure levels, and (6) expert ratings of auditory-perceptual diadochokinetic strength were assessed descriptively. RESULTS Perceived vocal exertion, lightheadedness, and subjective laryngeal diadochokinetic difficulty increased as back pressure increased. Number of intervals completed, auditory-perceptual diadochokinetic strength, and participant rankings of back pressure conditions, by contrast, decreased as back pressure increased. 0 and 5 cm H2O were the most preferred back pressure conditions overall. DISCUSSION Fluid back pressure was feasible and broadly tolerated during 15-minute trials of vocal exercise. However, the transition from 5 → 10 cm H2O appeared to represent an inflection point in our results: a minority of participants did not tolerate exercise at 10 cm H2O, becoming a majority at 15 cm H2O. We conclude that fluid back pressure should be restricted to values between 0 and 10 cm H2O during LDDK.
Collapse
Affiliation(s)
| | - Mary Sandage
- Department of Speech, Language & Hearing Sciences, Auburn University, Auburn, Alabama
| | | |
Collapse
|
4
|
Morton-Jones ME, Gladden LB, Kavazis AN, Sandage MJ. A Tutorial on Skeletal Muscle Metabolism and the Role of Blood Lactate: Implications for Speech Production. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:369-383. [PMID: 38157288 DOI: 10.1044/2023_jslhr-23-00531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
PURPOSE The purpose of this tutorial is threefold: (a) present relevant exercise science literature on skeletal muscle metabolism and synthesize the limited available research on metabolism of the adult human speech musculature in an effort to elucidate the role of metabolism in speech production; (b) introduce a well-studied metabolic serum biomarker in exercise science, lactate, and the potential usefulness of investigating this metabolite, through a well-established exercise science methodology, to better understand metabolism of the musculature involved in voice production; and (c) discuss exercise physiology considerations for future voice science research that seeks to investigate blood lactate and metabolism in voice physiology in an ecologically valid manner. METHOD This tutorial begins with relevant exercise science literature on the basic cellular processes of muscle contraction that require energy and the metabolic mechanisms that regenerate the energy required for task execution. The tutorial next synthesizes the available research investigating metabolism of the adult human speech musculature. This is followed by the authors proposing a hypothesis of speech metabolism based on the voice science literature and the application of well-studied exercise science principles of muscle physiology. The tutorial concludes with a discussion and the potential usefulness of lactate in investigations to better understand the metabolism of the musculature involved in vocal demand tasks. CONCLUSION The role of metabolism during speech (respiratory, laryngeal, and articulatory) is an understudied yet critical aspect of speech physiology that warrants further study to better understand the metabolic systems that are used to meet vocal demands.
Collapse
Affiliation(s)
| | | | | | - Mary J Sandage
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
| |
Collapse
|
5
|
Crosby T, Ezeh UC, Achlatis S, Kwak PE, Amin MR, Johnson AM. Vocal Health Assessment of Professional Performers Returning to the Stage After the COVID-19 Pandemic Shutdown. J Voice 2024:S0892-1997(24)00002-X. [PMID: 38296764 DOI: 10.1016/j.jvoice.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVES/HYPOTHESIS This study assessed the vocal health of performers returning to full-time performance after the COVID-19 pandemic shutdown and investigated how differences in voice usage, exposure to voice care professionals, and vocal pathology before and during the pandemic contributed to variability in self-perceived and instrumental vocal outcome measures. STUDY DESIGN This was a prospective, case-control observational study conducted at a single outpatient site. METHODS Twenty-two patients, 11 cases and 11 controls, were enrolled for the study. All participants were full-time singing professionals prior to the COVID-19 pandemic. Cases were recruited from patients presenting to a tertiary care voice center for vocal or pharyngeal complaints. Controls were healthy volunteers recruited from the general population of professional singers in the surrounding metropolitan area. All participants provided responses to the Voice Handicap Index-10, Evaluation of Ability to Sing Easily, and Laryngopharyngeal Measure of Perceived Sensation validated questionnaires as well as a study survey with questions regarding vocal use and history prior to and during the pandemic. All participants underwent instrumental acoustic and videostroboscopic voice evaluations. RESULTS Cases had poorer outcome measures overall and were more likely to report their voices were worse at study enrollment when compared to their prepandemic perception (P = 0.027). Cases tended to be older and less likely to have pursued alternative employment during the pandemic that involved increased speaking voice use (27% vs 55%), but these differences were not statistically significant. CONCLUSIONS There was a variable response among performers to the prolonged hiatus from performing during the COVID-19 pandemic. Those with poorer outcomes tended to be older and may have used their voice less during the pandemic. These findings are consistent with detraining periods in the exercise physiology literature and support the construct of treating vocal performers as vocal athletes.
Collapse
Affiliation(s)
- Tyler Crosby
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York
| | - Uche C Ezeh
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York
| | - Stratos Achlatis
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York
| | - Paul E Kwak
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York
| | - Milan R Amin
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York
| | - Aaron M Johnson
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York.
| |
Collapse
|
6
|
Venkatraman A, Fujiki RB, Sivasankar MP. A Review of Factors Associated with Voice Problems in the Fitness Instructor Population. J Voice 2023; 37:805.e13-805.e17. [PMID: 34154914 DOI: 10.1016/j.jvoice.2021.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/11/2022]
Abstract
There is a high prevalence of reported dysphonia symptomology in the fitness instructor population. This is concerning as these reported symptoms of dysphonia, aphonia, and vocal fatigue can significantly compromise quality of life. The purpose of this review is to explore key factors that may contribute to voice problems in the fitness instructor population. Voicing with concurrent phonation and exercise may be influenced by (1) the increased cardiovascular requirement during exercise, (2) the increased cognitive load associated with dual tasking, (3) the altered hydration state associated with prolonged exercise, and (4) the phonatory dose associated with continued voicing with loud background music. This manuscript will explore the literature on these key factors (ie, phonatory dose, dehydration, metabolic bioenergetics, cognitive load, and psychosocial stress) as they pertain to fitness instructors.
Collapse
Affiliation(s)
- Anumitha Venkatraman
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, USA.
| | - Robert Brinton Fujiki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, USA
| | - M Preeti Sivasankar
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, USA
| |
Collapse
|
7
|
Bioenergetic Evaluation of Muscle Fatigue in Murine Tongue. Dysphagia 2022:10.1007/s00455-022-10537-y. [DOI: 10.1007/s00455-022-10537-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/26/2022] [Indexed: 11/21/2022]
Abstract
AbstractMuscle fatigue is the diminution of force required for a particular action over time. Fatigue may be particularly pronounced in aging muscles, including those used for swallowing actions. Because risk for swallowing impairment (dysphagia) increases with aging, the contribution of muscle fatigue to age-related dysphagia is an emerging area of interest. The use of animal models, such as mice and rats (murine models) allows experimental paradigms for studying the relationship between muscle fatigue and swallowing function with a high degree of biological precision that is not possible in human studies. The goal of this article is to review basic experimental approaches to the study of murine tongue muscle fatigue related to dysphagia. Traditionally, murine muscle fatigue has been studied in limb muscles through direct muscle stimulation and behavioral exercise paradigms. As such, physiological and bioenergetic markers of muscle fatigue that have been validated in limb muscles may be applicable in studies of cranial muscle fatigue with appropriate modifications to account for differences in muscle architecture, innervation ratio, and skeletal support. Murine exercise paradigms may be used to elicit acute fatigue in tongue muscles, thereby enabling study of putative muscular adaptations. Using these approaches, hypotheses can be developed and tested in mice and rats to allow for future focused studies in human subjects geared toward developing and optimizing treatments for age-related dysphagia.
Collapse
|
8
|
Improvement in Tongue Pressure Precedes Improvement in Dysphagia in Dermatomyositis. Clin Pract 2022; 12:797-802. [PMID: 36286069 PMCID: PMC9600123 DOI: 10.3390/clinpract12050083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 11/23/2022] Open
Abstract
Dysphagia is known to occur in patients with dermatomyositis. However, the sudden-onset dysphagia without other symptoms can make diagnosis and treatment challenging. Two patients who did not have a severe muscle weakness complained of the sudden inability to swallow solids and liquids. The muscle biopsy results showed the perifascicular atrophy, and the patients were diagnosed with dermatomyositis. Videofluoroscopy revealed an inadequate pharyngeal contraction and a decreased upper esophageal sphincter opening with silent aspiration. Both patients showed low tongue pressures. Patient 1 received intravenous and oral methylprednisolone, and patient 2 received intravenous immunoglobulin in addition to intravenous and oral methylprednisolone. Several months after the onset of the dysphagia, the swallowing function of both patients improved. The improvement in tongue pressure preceded an improvement in the subjective and objective measurements of dysphagia. In conclusion, tongue pressure may be useful for predicting early improvement in swallowing function.
Collapse
|
9
|
Shembel AC, Nanjundeswaran C. Potential Biophysiological Mechanisms Underlying Vocal Demands and Vocal Fatigue. J Voice 2022:S0892-1997(22)00220-X. [PMID: 36008185 PMCID: PMC9943805 DOI: 10.1016/j.jvoice.2022.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 10/15/2022]
Abstract
Patients with complaint of vocal fatigue have perceptual, acoustic, and aerodynamic outcomes that are heterogeneous in nature. One reason may be due to different underlying biophysiological mechanisms that lead to these heterogeneous clinical presentations. Five potential mechanisms are proposed: neuromuscular, metabolic, vocal tissue, afferent, and central neural. Analytical frameworks and study designs to study these mechanisms are also addressed. A better understanding of biophysiological mechanisms of vocal fatigue can improve precision of therapeutic approaches. It can also help shift management from symptom-based to etiology-focused approaches for vocal fatigue.
Collapse
Affiliation(s)
- Adrianna C Shembel
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Dallas, Texas; Department of Otolaryngology-Head and Neck, Voice Center, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Chaya Nanjundeswaran
- Department of Audiology & Speech Language Pathology, East Tennessee State University, Johnson City, Tennessee
| |
Collapse
|
10
|
Nanjundeswaran C, Shembel AC. Laying the Groundwork to Study the Heterogeneous Nature of Vocal Fatigue. J Voice 2022:S0892-1997(22)00210-7. [PMID: 35945099 PMCID: PMC9899868 DOI: 10.1016/j.jvoice.2022.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 02/08/2023]
Abstract
Vocal fatigue has remained an elusive construct-despite its significant impact on communication, vocation, and quality of life. Current frameworks define vocal fatigue in the context of vocal demands and vocal demand-responses. However, the impact of factors like individuals' baseline vocal fitness and perception of the demand are not well understood. What is also not well understood are the effects of specific vocal demand ingredients on an individual's vocal demand responses. Furthermore, current outcome measures utilized to capture vocal fatigue lack sensitivity and underlying mechanisms are poorly understood. These gaps have led to inconclusive next steps in how to best define, assess, monitor, and manage vocal fatigue. A conceptual framework is needed to study and better understand vocal fatigue constructs. Such a framework should consider the individual's baseline physiology, psychology, key vocal demand ingredients, and biophysiological mechanisms underlying demand responses. The objective of this paper is to help the reader better understand the complex and heterogeneous nature of vocal fatigue and its impact on reliable assessment and monitoring. Future studies will require better elucidation of vocal demand ingredients, will need more sensitive vocal demand response measures, and will need to take in to account an individual's baseline physiology and psychological factors.
Collapse
Affiliation(s)
- Chaya Nanjundeswaran
- Department of Audiology & Speech Language Pathology, East Tennessee State University, Johnson City, Tennessee.
| | - Adrianna C Shembel
- School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Dallas, Texas; Department of Otolaryngology-Head and Neck, Voice Center, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
11
|
Abstract
The application of exercise science training knowledge has been of growing interest to voice professionals. This tutorial, derived from the authors' invited presentations from the "Exercise and the Voice" Special Session at the 2018 Voice Foundation Symposium, proposes a foundational theoretical structure based in exercise science, clarifies the wide range of variables that may influence voice training, and summarizes our present understanding of voice physiology from the perspective of muscle training. The body of literature on voice exercise was then analyzed from the perspective of this framework, identifying what we currently know and what we still have yet to learn.
Collapse
Affiliation(s)
- Aaron M Johnson
- Department of Otolaryngology - Head and Neck Surgery, New York University Voice Center, New York University School of Medicine, New York, New York.
| | - Mary J Sandage
- Department of Communication Disorders, Auburn University, Auburn, Alabama
| |
Collapse
|
12
|
Fuentes Aracena C, Biermann C, Catrín L, Zúñiga T. Características perilaríngeas y semiológicas de mujeres con odinofonía. REVISTA DE INVESTIGACIÓN EN LOGOPEDIA 2021. [DOI: 10.5209/rlog.69857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
El objetivo de este estudio es analizar las características perilaríngeas y semiológicas de mujeres con odinofonía. Mediante el uso de algometría de presión, de una escala numérica y de una encuesta sometida a procesos de validación y de consistencia interna, se trabajó con 40 participantes de sexo femenino. Se formaron dos grupos de 20 sujetos cada uno (G1 o asintomático y G2 o con odinofonía). Los umbrales de presión de G1 se encontraron entre los 1000 y 2700 gramos, mientras que los de G2 fluctuaron entre los 500 y 2000 gramos (p = 0.000). El 60 % de las participantes indicó que el lugar de menor umbral de presión es donde siente habitualmente el dolor durante la fonación. A su vez, se observó que la odinofonía es una condición que mejora con el descanso, se acompaña principalmente de sensación de irritación y de picazón del tracto vocal, su localización tiende a ser precisa y ocasionalmente afecta a la deglución. Por último, se observó que la intensidad habitual de la odinofonía es moderada. En conclusión, la odinofonía se trata de una condición que se produce con la sobrecarga vocal y se acompaña de aumento en la sensibilidad perilaríngea. Las mujeres con odinofonía presentan características semiológicas y psicosociales específicas para su condición.
Collapse
|
13
|
Weinreb SF, Piersiala K, Hillel AT, Akst LM, Best SR. Dysphonia and dysphagia as early manifestations of autoimmune inflammatory myopathy. Am J Otolaryngol 2021; 42:102747. [PMID: 33038783 DOI: 10.1016/j.amjoto.2020.102747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE While dysphagia is a recognized manifestation of autoimmune inflammatory myopathy, a relationship between myositis and dysphonia or laryngeal pathology is not well-documented. We therefore sought to describe the spectrum of laryngeal disorders present in myositis patients, evaluate whether any specific conditions are overrepresented among these patients compared to a large treatment-seeking population, and examine the clinical course and outcomes of these symptoms. MATERIALS AND METHODS This was a retrospective chart review, including all patients seen at the Johns Hopkins Voice Center between January 2016 and December 2017. Demographic data, comorbidities, and laryngeal diagnoses were extracted from the electronic medical record. The charts of patients with myositis were reviewed further to ascertain details of their laryngeal symptoms and myositis disease course. Associations between myositis and dysphonia/dysphagia were evaluated using binary regression and multinomial logistic regression models to adjust for age, sex, race, and smoking status. RESULTS Of 4252 patients, sixteen had myositis. Compared to 4236 controls, these patients had significantly higher odds of presenting with muscular voice disorders (adjusted odds ratio (OR*) = 4.503, p* = 0.005) and dysphagia (OR* = 6.823, p* < 0.001). A majority (64.3%, CI:35.6-93.0%) of myositis patients had laryngeal pathology among the presenting symptoms of their myositis. Across all diagnostic categories, there was a non-significant trend towards better outcomes in patients receiving specific interventions for their laryngeal symptoms. CONCLUSIONS Muscular voice disorders and dysphagia are significantly overrepresented in myositis patients presenting to a laryngology clinic, and in these patients, both are frequently among the presenting symptoms of myositis.
Collapse
Affiliation(s)
- Samuel F Weinreb
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, 601 N Caroline Street, Baltimore, MD, USA
| | - Krzysztof Piersiala
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, 601 N Caroline Street, Baltimore, MD, USA; Division of ENT Diseases, Department of Clinical Sciences, Intervention, and Technology, Karolinska Institute, Solnavägen 1, 171 77 Stockholm, Sweden
| | - Alexander T Hillel
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, 601 N Caroline Street, Baltimore, MD, USA
| | - Lee M Akst
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, 601 N Caroline Street, Baltimore, MD, USA
| | - Simon R Best
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, 601 N Caroline Street, Baltimore, MD, USA.
| |
Collapse
|
14
|
Allison LH, Sandage MJ, Weaver AJ. Vocal Dose for Rhythm-Based Indoor Cycling Instructors: With and Without Amplification. J Voice 2020; 34:963.e23-963.e31. [DOI: 10.1016/j.jvoice.2019.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/13/2019] [Accepted: 05/15/2019] [Indexed: 10/26/2022]
|
15
|
Snell EN, Plexico LW, Weaver AJ, Sandage MJ. Quantifying Vocal Power: Correlation of Whole-Body Anaerobic Power to Vocal Function Measures. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:2597-2608. [PMID: 32692587 DOI: 10.1044/2020_jslhr-20-00110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose The purpose of this preliminary study was to identify a vocal task that could be used as a clinical indicator of the vocal aptitude or vocal fitness required for vocally demanding occupations in a manner similar to that of the anaerobic power tests commonly used in exercise science. Performance outcomes for vocal tasks that require rapid acceleration and high force production may be useful as an indirect indicator of muscle fiber complement and bioenergetic fitness of the larynx, an organ that is difficult to study directly. Method Sixteen women (age range: 19-24 years, M age = 22 years) were consented for participation and completed the following performance measures: forced vital capacity, three adapted vocal function tasks, and the horizontal sprint test. Results Using a within-participant correlational analyses, results indicated a positive relationship between the rate of the last second of a laryngeal diadochokinesis task that was produced at a high fundamental frequency/high sound level and anaerobic power. Forced vital capacity was not correlated with any of the vocal function tasks. Conclusions These preliminary results indicate that aspects of the laryngeal diadochokinesis task produced at a high fundamental frequency and high sound level may be useful as an ecologically valid measure of vocal power ability. Quantification of vocal power ability may be useful as a vocal fitness assessment or as an outcome measure for voice rehabilitation and habilitation for patients with vocally demanding jobs.
Collapse
Affiliation(s)
- Emily N Snell
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
| | - Laura W Plexico
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
| | - Aurora J Weaver
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
| | - Mary J Sandage
- Department of Speech, Language, and Hearing Sciences, Auburn University, AL
| |
Collapse
|
16
|
Exercise Science and the Vocalist. J Voice 2019; 35:376-385. [PMID: 31628045 DOI: 10.1016/j.jvoice.2019.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/11/2019] [Accepted: 09/13/2019] [Indexed: 01/18/2023]
Abstract
The application of exercise science training knowledge has been of growing interest to voice professionals. This tutorial, derived from the authors' invited presentations from the "Exercise and the Voice" Special Session at the 2018 Voice Foundation Symposium, proposes a foundational theoretical structure based in exercise science, clarifies the wide range of variables that may influence voice training, and summarizes our present understanding of voice physiology from the perspective of muscle training. The body of literature on voice exercise was then analyzed from the perspective of this framework, identifying what we currently know and what we still have yet to learn.
Collapse
|
17
|
Epperson HE, Sandage MJ. Neuromuscular Development in Neonates and Postnatal Infants: Implications for Neuromuscular Electrical Stimulation Therapy for Dysphagia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:2575-2583. [PMID: 31343903 DOI: 10.1044/2019_jslhr-s-18-0502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose The aim of the current study was to review neuromuscular development, summarize the current body of evidence describing the use of neuromuscular electrical stimulation (NMES) therapy in infants, and identify possible contraindications for the use of NMES in the neonate and young infant. Method After a review of the literature describing neuromuscular development, we created a timeline of the developmental processes. Key milestones were determined, and a literature search was conducted to identify potential effects of electrical stimulation on this process. Results Current evidence supporting the use of NMES in the pediatric population is limited and of poor quality. Contraindications of the use of NMES in the neonate and young infant were identified, including (a) inhibited expression of the neural cell adhesion molecule that is vital for neuromuscular development, (b) alteration of muscle fiber type metabolic profile away from intended muscle fiber type morphology, and (c) interruption of postsynaptic acetylcholine receptor synthesis during neuromuscular junction development. Conclusion The use of NMES for the treatment of dysphagia in the neonate and young infant may influence early neuromuscular development in a manner that is not currently well understood. Future research is needed to further understand the effects of NMES on the developing neuromuscular system.
Collapse
Affiliation(s)
| | - Mary J Sandage
- Department of Communication Disorders, Auburn University, AL
| |
Collapse
|
18
|
Lenell C, Sandage MJ, Johnson AM. A Tutorial of the Effects of Sex Hormones on Laryngeal Senescence and Neuromuscular Response to Exercise. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:602-610. [PMID: 30950744 PMCID: PMC6802894 DOI: 10.1044/2018_jslhr-s-18-0179] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Purpose The purpose of this tutorial is to summarize how sex hormones affect both laryngeal senescence and neuromuscular response to exercise, highlighting the importance of considering sex differences in developing treatment for the senescent voice. Conclusion Men and women's voices are sexually dimorphic throughout the life span, including during the laryngeal adaptations observed during senescence. Therefore, presbyphonia (age-related dysphonia) likely clinically manifests differently for men and women due to differences in how the male and the female larynx change in response to aging. Because sexual dimorphism is evident in both laryngeal aging and response to exercise, voice therapy programs aimed at treating the typical and disordered aged voice should consider sex differences in their design.
Collapse
Affiliation(s)
- Charles Lenell
- Department of Communicative Sciences and Disorders, New York University, New York
| | - Mary J. Sandage
- Department of Communication Disorders, Auburn University, AL
| | - Aaron M. Johnson
- Department of Communicative Sciences and Disorders, New York University, New York
- New York University Voice Center, Department of Otolaryngology—Head & Neck Surgery, New York University School of Medicine, New York
| |
Collapse
|
19
|
|